Therapy Isn't Brain Science

Knowledge Doesn’t Replace Clinical Skill

By Steve Andreas

Therapists were doing helpful work long before neuroscience made its official debut and the field developed a collective case of “brain fever.” In fact, at this stage of its development, neuroscience may be irrelevant to what needs to happen in therapy.

Some years ago, during the heyday of the self-esteem movement, I was invited to teach at a large weekend drug and alcohol conference. Most of the presenters talked about how critical it was to build up clients’ positive self-concepts to help them stop using drugs. But while everyone seemed convinced that self-esteem was important, when I asked my workshop group what exactly self-esteem was and, more important, how they could help clients enhance theirs, the room went quiet.

“OK,” I said. “Let’s imagine that I’m hooked on drugs. Help me improve my self-concept. Help me out. What should I do?”

“Well, you could use operant conditioning,” someone suggested.

“Great!” I responded. “Condition me. Show me what you can do to help me improve my self-esteem.”

“OK,” I said. “Let’s imagine that I was sexually abused as a child. Show me how to build up my self-concept in a way that’ll heal that.”

Again, the room went quiet. My point in keeping up this line of questioning for almost 20 minutes was to make a clear distinction between what psychologist and communications theorist Paul Watzlawick called descriptive language—which tells you about something—and injunctive language—which tells you what to do. It’s the difference between describing a meal to someone and handing over a recipe.

The newest edition of the Diagnostic and Statistical Manual has more than 900 pages describing the different kinds of disorders that people have, but not a single page telling us what to do to resolve them. As therapists, we’re useless to our clients if all we can do is describe what’s wrong with them. We need to create vivid, living experiences for them that’ll help them change. All the expert knowledge in the world about therapy or different psychiatric conditions isn’t worth a thing if we don’t know what to do with it.

Nothing reflects this fundamental truth more than the current infatuation with brain science. I think it’s wonderful that we now have at least some understanding of neural connectivity, synapses, brain chemistry, and mirror neurons—all of which help us understand our ability to change the way we think and act, and to experience empathy and compassion. I have great respect for the value of doing valid research in such an inherently complex field. However, what I’ve found in a close reading of original neuroscience studies is that many of the uncertainties and complexities in brain science research don’t appear in the popularized material written for the general public—and for therapists. Even if we set aside all the uncertainties and assume that current neuroscience studies are valid and won’t be revised substantially by further research, the key question remains: What can neuroscience tell us about what to do differently when we’re working with a client?

In recent years, I’ve listened to many of the current experts in neuroscience talk about their interesting discoveries, and I’ve watched therapy demonstrations by the few who’ve tried to apply findings from the brain-imagery lab to actual therapy with a client, but so far, I haven’t seen any persuasive direct application of neuroscience to the practice of therapy.

Physicists found a while ago that the cosmos is made up of subatomic particles that interact in peculiar ways, and they went on to develop detailed and sometimes frighteningly effective recipes to put that information to practical use—think cell phones and hydrogen bombs. However, brain science has yet to translate its findings into effective or practical recipes for therapists. For instance, a lot of therapists are enthusiastic about the fact that they now know that a panic attack involves overactivation of the amygdala, but this knowledge doesn’t make them better therapists. Would they do their therapy any differently if they were told that a panic attack actually involved overactivation of the liver—or even the pineal gland, which Descartes believed to be the seat of the soul and the place where all thinking originated? I don’t think so.

15 comments

I fully support Andreas. A probable reason may be that both of us became therapists long before “neuroscience” acquired its imaging machinery. We were able to attend to the practice of psychotherapy as it presented itself in clients’ experiences rather than viewing it through the lens of another frame of reference. Neuroscience AND the current mainstream view of psychotherapy share the same limited perspective on what psychotherapy can accomplish. Both view effective treatment as a better way to cope with your problem rather than resolving it. What would we think of a medical science that settled for the partial healing of an injury or an illness? The field of psychotherapy has burdened itself with a self-inflicted blind spot about the therapeutic value of emotional experiencing. The fear of re-traumatization is based on a false premise; i.e., that heightened emotional experiencing means that the person is being “re-hurt.” See my article in PN, May/June, 2012, as well as ones in PsycINFO. The key to the maximum effectiveness of any therapy is the unforced activation of the client’s emotional experiencing; i.e., it arises coincident with the support the client receives for his experiencing. I can cite six well known researchers who agree that research has yet to demonstrate why psychotherapy works. I claim it works because of the unforced activation of emotional experiencing, which is the factor shared by all effective therapies despite how they are said to work. In “Is crying beneficial?” (Current Directions in Psychological Science, 2008, 17(6)), the authors concluded that “empirical research on crying is in its infancy.” Given that our beloved profession has existed since the late 1800s and that clients have been crying ever since, this is an absolutely astounding statement. I regard clients’ crying as Psychotherapy’s Best Kept Secret. I’ve yet to see a neuroscience discussion of crying. The best advice that Dan Siegel can offer for how to handle heightened emotional experiencing is “name and tame.” The best that Louis Cozolino (The neuroscience of psychotherapy: Healing the social brain, 2nd. ed.) can offer for why psychotherapy works is as a placebo. This leaves me wondering why “science” is in “neuroscience.” In this same text, there also appears: “When all is well and we are in a state of calm, there is no reason to learn anything new. When our needs for food, companionship, and safety are satisfied, the brain has done its job and there is no reason to invest energy in learning,” as well as, “We…intuitively understand that people need to be motivated and aroused to learn.” Do you find yourself in this description of our psychological nature? I certainly don’t. Maslow refuted this view decades ago. I challenge neuroscientists to compare the brains of people who are psychologically healthy with those who aren’t and when clients cry in a therapeutic way.

I notice that you don't mention Neurofeedback or biofeedback based approaches such as capnometry/heart rate variability and so forth and how they might be utilised. Neurofeedback has several hundred papers testifying to it's usefullness whereas NLP has, as far as I'm aware, only single case studies with no mention of failures. I presume you do have failures, or would they be reframed in some way? There are many approaches other than NLP. Can't you acknowledge their input?

Thank you dear Steve for choosing a topic which is pervasive among the practitioners nowadays and doing so shows just how much observant you are of the intellectual market of the FoNLP.

As your student, I wanted to communicate a few things that came to my mind, regarding the article. I really enjoy your writings for many reasons amongst which is how you avoid cliches avoid regurgitated stuff. So to read that paragraph in which you mention 'the DSM-V and the 900 pages of description' seemed a bit out of character to me. Firstly it is a 'Diagnostic' manual and secondly there is a section named 'course' for every disorder in the book which proposes the course of treatment. These treatments may not be aligned with the kind of treatments that we hope for or the book might lack treatments for some of the disorders but still, to frame it as a '900 pages of problems' is to descend to the level of 'the word on the street' which you specifically invite us, the readers, to avoid.

The other point was 'the moral of the article' or 'the conclusion' which was not clear to me. Since in NLP and specially in this article you are inviting the readers to pay attention to the spirit of NLP which is 'Do what works', are you actually inviting the reader 'do not study neuroscience'? Surely you haven't written this relatively long article as a way of expressing 'I think Neuroscience is irrelevant' without any practical purpose in mind, have you? and even if it is just about that (expressing a concern), don't you think that this sort of 'expressions' would invite heavy & unnecessary criticisms from outside the field? I mean, at the moment, do we need to be known as people who 'argue for ignorance'? This probably comes from people who don't know you are a member of the board of an active group who rigorously study NLP.

Also, I'm a bit confused about the structure of the article and mainly about the relevancy of the 2 examples you presented (although I enjoyed them profoundly). If I understood it correctly, you first introduced your topic and then your claim and then you brought up 2 examples to show that no neuroscience was involved in these effective techniques. was that it? That is akin to saying "I believe wheels can not be used in an airplane. Now, to illustrate my point, let me give you examples of planes which do fine without wheels!" which is logically unnecessary and irrelevant to the argument, considering that they constitute almost 2/3 of the article. In fact, as you know it far better than me, we can not prove one method ineffective by telling anecdotes about the effectiveness of other methods. So, I couldn't find the point.

Anyways, I hope the feedback proves useful. I use the opportunity to sincerely thank you for everything positive you've done for NLP over the years, Steve.
All the best,

Good observations! Any therapist or practitioner working with clients week in week out would IMO probably agree. In the internet age so often folks forget that what actually creates genuine results for people trumps all the academic theory every time. That's not to say such research has not value, rather that real life substantive change is more useful...

I agree with knowledge verses pragmatic ability to help. Why I became a Hypnotherapist. 25 years of reading psychotherapy left me frustrated. I knew more and more about people's difficulties with no greater ability to assist in their resolution. Neuro- science is part of the pursuit of curing emotional problems via Chemical means. Years ago I wrote a line in a poem, "Might as well to find a thought, dissect a brain." which was my attempt to debunk this kind pseudo rationality. I was incidentally a scientist in my orientation as a youth.